| NPI | 1356884241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP133097) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 807333) |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2017-02-24 |